Pulmonary infections

Extract

I've had a fascination with Mycobacterium for a long time and I haven't fully figured out where it comes from. What is it about this genus that is so intriguing? And in some cases so deadly. As a trainee in Ireland, I had what you might call a “healthy” exposure to Mycobacterium tuberculosis, with experiences varying from simply managing drug–drug interactions up to fatal disease in immunocompromised patients. In New York, I saw a different side of mycobacterial disease; at a tuberculosis (TB) centre in a city with a big immigrant population and in conjunction with the Department of Health, I dealt with some difficult cases of MDR- and XDR-TB, as well as challenges with medication adherence, all while under guard by the NYPD! In parallel, through our growing non-cystic fibrosis bronchiectasis programme, we had a large population of nontuberculous mycobacterial patients; the same genus but a very, very different and heterogeneous disease. Through this programme and with incredible support from New York University, thus began my transition into microbiome research, which has been a journey to say the least.

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An introduction to two issues of Breathe that focus on pulmonary infections https://bit.ly/4aFmbGI

I've had a fascination with Mycobacterium for a long time and I haven't fully figured out where it comes from. What is it about this genus that is so intriguing? And in some cases so deadly. As a trainee in Ireland, I had what you might call a “healthy” exposure to Mycobacterium tuberculosis, with experiences varying from simply managing drug–drug interactions up to fatal disease in immunocompromised patients. In New York, I saw a different side of mycobacterial disease; at a tuberculosis (TB) centre in a city with a big immigrant population and in conjunction with the Department of Health, I dealt with some difficult cases of MDR- and XDR-TB, as well as challenges with medication adherence, all while under guard by the NYPD! In parallel, through our growing non-cystic fibrosis bronchiectasis programme, we had a large population of nontuberculous mycobacterial patients; the same genus but a very, very different and heterogeneous disease. Through this programme and with incredible support from New York University, thus began my transition into microbiome research, which has been a journey to say the least.

Enough about me; it is a great pleasure to introduce this issue of Breathe which, together with the final issue of 2025, focuses on pulmonary infection. You might say this is a broad topic, and you are right! Therefore, we have spread these educational articles over two issues. As an introduction to this vast topic, we have a wonderful article discussing an approach to respiratory sepsis from a pulmonary point of view [1]. Accompanying this, Al-Zergani et al. [2] take us through the risks and benefits of macrolide therapy for community-acquired pneumonia, while Sharplin and Goyal [3] discuss Mycoplasma pneumoniae in children.

Infection beyond the parenchyma can frequently descend into the pleural space and, as discussed in our July 2025 issue on interventional pulmonology, interest in pleural disease has really seen a spike of late, both from a clinical and a research point of view. Here, from our surgical colleagues we have a great review on the surgical interventions in pleural infection [4] and a fascinating interactive case of medical thoracoscopy [5]. In our ultrasound corner we have a viewpoint exploring quantitative thoracic ultrasound imaging [6]. Additionally, for those physiology fans we have a great article reviewing the root of shortness of breath in pleural effusions [7].

I started this editorial discussing my fascination with Mycobacterium and thus we have several pieces concerning this disease, including two excellent interactive cases [8, 9]. The effects of pulmonary infection in some cases can be long lasting and thus we have a great article on post-TB lung disease [10], secondary infections following TB [11] as well as rehabilitation for individuals with post-TB lung disease [12]. Similarly, since 2020 we have seen varying consequences of another infectious disease, SARS-CoV-2, and we have a great review on post-COVID-19 interstitial lung disease [13], just in time for the winter season.

Having said that, we have all been celebrating a very festive and thankful season. And after just flying back from NYC, where Christmas was in full swing, I'm feeling particularly festive and hope everyone had a wonderful time over the holiday period. There are some changes happening in the journal, but as always, I would like to thank all our authors, associate editors (new and retired), ERS Assembly Secretaries (new and retired) and the editorial team for helping me put this issue together.